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Medi-Cal Managed Care. PSC Orientation November 2, 2011. Medi-Cal Managed Care & CPSP. Three different Managed Care Models Geographic Managed Care County-Organized Health System Two-Plan 33 Counties have MCMC. Medi-Cal Managed Care. MCMC Contracting Hierarchy State Health Plans
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Medi-Cal Managed Care PSC Orientation November 2, 2011
Medi-Cal Managed Care & CPSP • Three different Managed Care Models • Geographic Managed Care • County-Organized Health System • Two-Plan • 33 Counties have MCMC
Medi-Cal Managed Care • MCMC Contracting Hierarchy • State • Health Plans • Subcontracting Health Plans (2-Plan Only) • IPAs/Medical Groups • Providers
Medi-Cal Managed Care • All plans must have MOU with local MCAH describing roles & responsibilities: • Outreach • Perinatal access • Provider network • Education • Training • Information sharing
Medi-Cal Managed Care: What Every Provider Needs to Know • READ THE CONTRACT! • CPSP is a managed care benefit • All managed care enrollees eligible • Reimbursement method varies by contract • Capitation or separate fee-for-service rate • Cannot bill Medi-Cal for managed care clients • May need prior authorization for high risk referrals
Medi-Cal Managed Care • Client Care Problems • Office of the Ombudsman 1-888-452-8609 • Department of Managed Health Care 1-800-400-0815
